The Commissioners’ plan for a separate stream of services to make reablement a major focus of Australia’s aged care system has received the tick of approval from sector leaders – but with caveats including better data collection and analysis, more incentives for providers to offer restorative care, public reporting of quality measures and a different funding approach for respite care.
For just under two hours, Senior Counsel Assisting Peter Gray QC (pictured above) led a discussion around how the ‘Investment Stream’ (which Silver Chain has suggested be renamed the ‘Reablement Stream’) proposed in Consultation Paper 1 and how it could be implemented to fund interventions to help restore functioning, provide respite and delay or prevent progression to more intensive forms of care with the seven witnesses:
- Professor Julie Ratcliffe – a Mathew Flinders Fellow, Professor of Health Economics in the College of Nursing and Health Sciences and lead for the Caring Futures Institute, Flinders University
- Dr Gill Lewin – Curtin University (previously Research Director at Silver Chain for 22 years)
- Jaye Smith – First Assistant Secretary, Residential Care, Department of Health
- Dr Henry Cutler – Director, Centre for Health Economy, Macquarie University
- Sue Elderton – CEO, Carers Australia
- Dr David Panter – CEO at ECH, and LASA Board member
- Patricia Sparrow – CEO, Aged and Community Services Australia
The panel appeared to be widely supportive of establishing a stream to support reablement and restorative care, but pointed to a number of requirements that would be needed to successfully implement this strategy, including:
Better collection and analysis of data:
The Senior Counsel noted that former Australian Institute of Health and Welfare (AIHW) senior manager Mark Cooper-Stanbury (who gave evidence at the first Adelaide hearings in February 2019) had made a submission to the Consultation Paper pointing to considerable gaps in the national collection and analysis of data in aged care.
Dr Lewin (pictured below right) backed this view, saying it was important to establish a minimum data set – with measures that are actually clinically useful – as part of the stream.
Mr Smith (pictured below left) qualified the Department is doing “work” around integrating the data captured by My Aged Care with other health services – but said he would need to come back with a more comprehensive answer.
“Might it also be helpful, Mr Smith, as well as that update, you provide us about what could constitute a really quality sound minimum data set,” Commissioner Lynelle Briggs requested.
“Yes,” agreed Mr Smith.
Provide more incentives to providers to reable clients – with public reporting of data:
Dr Cutler (pictured below right) argued more could be done to incentivise providers to improve quality, including public reporting of performance data.
“There should be some consideration around developing and publicly reporting a robust quality performance framework in Australia that not only looks at clinical outcomes but all other areas that impact our wellbeing,” he stated. “So, for example, social inclusion.”
Again, Mr Smith said the Department is working on building in incentives for restorative care in service provision – no more detail though.
Introduce clinical indicators on outcomes including quality of life:
Prof Ratcliffe (pictured above left) revealed her team is currently developing a series of indicators due for release at the end of 2020 around quality of life.
Remove supply restrictions on aged care places:
Prof Ratcliffe also made a clear case for eliminating the Aged Care Approvals Round (ACAR).
“The research suggests that there is less incentive for providers to deliver quality care through the market when there are high occupancy rates because they have access to residents and they don’t necessarily need to go out and increase their quality to attract more residents,” she said.
A set of guiding principles to determine if a person will benefit from access:
Dr Cutler said this should be based on the likelihood of the care recipient achieving better outcomes or avoiding costs down the track.
A cost benefits analysis of the Stream:
Both Dr Cutler and Prof Ratcliffe agreed this was necessary at the program level to ensure the money was being spent where it could produce the best outcomes.
A different funding approach for respite care:
While the panel welcomed the funding for reablement, they warned that respite care was likely to need different funding arrangements to reablement services like home modifications.
“A block funding arrangement, which is a really simple way of allocating funding may not necessarily be the right approach,” Dr Cutler explained. “It doesn’t really provide any incentive to improve quality or maintain costs but other approaches such as a capitation approach where people are enrolled in a particular service and they can use that service in an episodic nature may be appropriate.”
Ms Elderton agreed it was too early to consider funding respite using a package approach because of the lack of dedicated respite options available and capital funding would be needed first to encourage development.
Dr Panter also advocated for the idea of pooling funds for older people from primary care, hospital care and aged care – a model he already put forward during the second Melbourne hearings in October 2019.
An ‘active’ assessment process:
Dr Lewin pushed for an assessment where care recipients are automatically provided with reablement – rather than asked if they would like it instead of a service (like Denmark’s system of mandatory reablement).
“I think there should be a period of time when a specialised team work with the individual to assist them to optimise their health and functioning and then one considers what, if any, ongoing support they need,” she said.
The assessment process would also need to be ongoing, she added, as people regain capabilities and confidence.
Services should be free – to a point:
The Consultation Paper states these services will not come out of recipients’ packages but from other forms of funding and the panel was on board – to an extent.
Dr Cutler acknowledged that while the ‘Investment Stream’ should be provided to older people as long as the benefits outweigh the costs, the reality is the Government has a limited budget for services.
He recommended Government provide a level of service with consumers making co-contributions after then.
The final cost will still be substantial however – will the Government want to foot the bill?